Apparatus for stabilizing vertebral bodies

ABSTRACT

A dynamic stabilization apparatus comprises elongated members mounted within the proximal end of anchoring devices that are placed in adjacent vertebral bodies. A flexible element having elastic properties within the applicable range of loading, for example loads that the spine experiences, is disposed between the proximal ends of the elongated members. At least one additional flexible element is mounted about the proximal ends of the elongated members adjacent the central flexible element. A housing encapsulates the proximal ends of the members such that the flexible element and the additional flexible elements are contained therein. As compressive, tensile, angular, shear and rotational forces are applied to the elongated members the central flexible element and the additional flexible elements interact with the elongated members and the housing to allow for motion of the elongated members.

TECHNICAL FIELD

The present invention relates to stabilization of the vertebrae of the spinal column and, more particularly, to an apparatus whereby securing members are implanted and fixed into a portion of a patient's spinal column and a longitudinal member including flexible, semi-rigid rod-like structures of various cross-sections (hereinafter referred to as “rods”) are connected and fixed to the upper ends of the securing members to provide stabilization of the spinal column.

BACKGROUND

Degenerative spinal column diseases, for example, disc degenerative diseases (DDD), spinal stenosis, and spondylolisthesis can be corrected by surgical procedures. Typically, spinal decompression is the first surgical procedure that is performed and results in the reduction of pressure in the spinal canal and on nerve roots located therein. Spinal decompression seeks to remove tissue that is applying pressure to the nerve bundle and thus relieve pain. This can result, however, in weakening the spinal column.

Certain surgical procedures, for example posterolateral fusion whereby adjacent vertebral bodies are fused together is often necessary to restore spinal stability following the decompression procedure. Fusion of adjacent vertebral bodies requires that the bone grow together and employs a bone graft or other biological growth agent. In order to maintain the grafting material in place and preserve stability during bone growth, a spinal fixation device is typically used to support the spinal column until a desired level of fusion is achieved. Depending on a patient's particular circumstances and condition, a spinal fixation surgery can sometimes be performed immediately following decompression, without performing the fusion procedure. The fixation surgery is performed in most cases because it provides immediate postoperative stability and, if fusion surgery has also been performed, it provides support of the spine until sufficient fusion and stability has been achieved.

Conventional methods of spinal fixation utilize a rigid spinal fixation device to support and prevent movement of an injured spinal part. These conventional spinal fixation devices include: fixing screws configured to be inserted into the spinal pedicle or sacrum to a predetermined depth and angle, rods or plates configured to be positioned adjacent to the injured spinal part, and coupling elements for connecting and coupling the rods or plates to the fixing screws such that the injured portion of the spin is supported and held in a relatively fixed position by the rods or plates. The connection units prevent further pain and injury to the patient by substantially restraining the movement of the spinal column.

Because the connection units prevent normal movement of the spinal column, after prolonged use, the spinal fixation device can cause ill effects, such as adjacent level syndrome (transitional syndrome) or fusion disease that result in further complications and abnormalities associated with the spinal column. The high rigidity of the rods or plates used in conventional fixation devices causes these disorders due to the patient's joints being fixated by the nature of surgery. The movement of the spinal joints located above or under the operated area is increased. Consequently, such spinal fixation devices cause decreased mobility of the patient and increased stress and instability to the spinal column joints adjacent to the operated area.

It has been reported that excessive rigid spinal fixation is not helpful to the fusion process due to load shielding. As an alternative, semi-rigid spinal fixation devices have been utilized to address this problem while assisting the bone fusion process. For example, U.S. Pat. No. 5,375,823—Navas and U.S. Pat. No. 6,241,730—Alby each disclose a piston configuration mounted between fixing screws having a flexible material or spring element enclosed within a sleeve allowing for axial dampening Although providing for a greater range of motion than a fixed rod, these devices fail to accommodate for a full range of physiological motion, for example axial torsion or twisting, and are not well-suited for spinal stabilization absent fusion. Thus, in the end these devices do not fully prevent the problem of rigid fixation resulting from fusion.

To solve the above-described problems associated with rigid fixation, semi-rigid and generally flexible devices have been developed. U.S. Publication No. 2006/0264940—Hartmann discloses a flexible spring element connected to a rod and an axially opposed hollow body. The spring element and hollow body have corresponding bores that receive a clamping element. The clamping element has a convex face that abuts the end wall of the internal bore of the spring element during deformation of the spring element under axial loading of the device. The shape of the end of the clamping element controls the spring characteristics of element. While this device functions to provide a greater range of motion during compression it relies upon the spring element as a load bearing structure in tension. This is not an optimal design to handle the long-term cyclical loading the device will experience when implanted.

U.S. Pat. No. 5,672,175—Martin discloses a flexible spinal fixation device which utilizes a flexible rod made of metal alloy and/or a composite material. Additionally, compression or extension springs are coiled around the rod for the purpose of providing de-rotation forces on the vertebrae in a desired direction. However, this approach is primarily concerned with providing a spinal fixation device that permits “relative longitudinal translational sliding movement along [the] vertical axis” of the spine and has a solid construction with a relatively small diameter in order to provide a desired level of flexibility. Because they are typically very thin to provide suitable flexibility, such a rod is prone to mechanical failure and have been known to break after implantation in patients. Similarly, U.S. Publication No. 2007/0270814—Lim shows a vertebral stabilizer that has mobility during compression, extension and rotation. A connecting member such as flexible rods, cables or braided steel are anchored at their distal and proximal ends to engaging portions and are coaxially located within a flexible member. While the connecting members can bend to accommodate shear when the spine is twisted this device has been shown to fail due to fatigue once implanted.

There is no spinal fixation device that can provide for a full range of physiological motion when implanted in a patient. In addition, few devices that attempt to accommodate a range of physiological motion can withstand long-term loading conditions. Therefore, there is a need for an improved dynamic spinal fixation device.

SUMMARY

Elongated members such as rods, plates and the like are often mounted to span vertebral bodies in order to provide stability to localized regions of the spine. These devices are typically mounted to the vertebral bodies via an anchoring device such as a member having threads at its distal end, allowing for attachment to the spine and a proximal end that accepts the elongated member. For example, at least two threaded members are placed in adjacent vertebral bodies and the elongated members are mounted to the proximal end of threaded members so as to span the vertebral bodies. Rigid elongated bodies are typically employed in order to prevent motion between the vertebral bodies.

According to the invention, a dynamic stabilization apparatus is provided. The apparatus comprises elongated members such as rods mounted within a housing. The elongated members are mounted within the proximal end of anchoring devices that are placed in adjacent vertebral bodies. A central flexible element having elastic properties within the applicable range of loading, for example loads that the spine experiences, is disposed between the proximal ends of the elongated members. At least one additional flexible element is mounted about the proximal ends of the elongated members adjacent the central flexible element. The housing encapsulates the proximal ends of the members such that the central flexible element and the additional flexible elements are contained therein. As compressive, tensile, angular, shear and rotational forces are applied to the elongated members the central flexible element and the additional flexible elements interact with the elongated members and the housing to allow for motion of the elongated members. The degree of permissible motion may be varied, for example, by varying the material from which the flexible members are constructed.

The housing may be generally cylindrical and has openings at each end for receiving the elongated members there through. In one embodiment of the invention, the housing is constructed from a generally rigid material that will not deform under the physiological loading encountered within the spine. The housing may be formed from a first and a second casing wherein each of the casings have an opening therein. The casings include an engagement feature such that after the elongated members are inserted through the openings the casings are engaged together to assemble the apparatus.

In one embodiment of the invention the proximal ends of the elongated elements are larger than the central and distal portions of the elongated member. For example, one or both of the proximal ends are flanges. The flange includes an inward surface facing the central flexible element and an outward surface facing the distal end of said elongated member. The inward surface may be generally concave and contacts an outer facing surface of the central flexible clement that is convex. Alternatively, the inner surface of the flange may be convex while the contacting or outer surface of the central flexible element is concave. A variety of shapes for the two surfaces may be employed including having both surfaces be flat.

The central flexible member may be constructed from a polymer and has a first and a second outward facing surface. The central flexible member resists rotational and compressive forces. The inward surface of each of the flanges contacts the outer facing surfaces of the central flexible element. Protrusions located on either the outward surface of the central element or the inward surface of the flanges engages with corresponding recesses to form an anti-torsional coupling. As the elongated members are rotated about their axis in opposite directions the engagement of the protrusions within the recesses causes the central flexible element to elastically deform, resisting the motion. In addition, as the elongated members experience a compressive force the flanges engage the central flexible element. The central flexible element is compressed resisting while allowing motion of the elongate members. Eventually the central flexible element deforms such that it contacts the housing further increasing the resistance to the motion of the elongated members.

The outward surface of the proximal end of the elongate members or the flange contacts a surface of the additional flexible element. A variety of shapes can be employed for the outward surface of the flange and the corresponding contacted surface of the additional flexible element. The shaping of these surfaces may be varied in order to create a desired dynamic response. As with the central element, the additional flexible elements may be constructed from a polymer. The additional flexible elements serve as an axial and radial buffer between the housing and the elongated members. For example, as the elongated members are subjected to an axial or radial force, the flange pushes on and deforms the additional flexible member which resists the motion of the elongated members. Varying the elastic properties of the central and flexible members allows the load-displacement response of the apparatus to be customized.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of the invention will be apparent to those of ordinary skill in the art from the following detailed description of which:

FIG. 1 is an isometric view of to an embodiment of the present invention;

FIG. 2 is an exploded view of the components of an embodiment of the present invention.

FIG. 3 is a side view of an embodiment of the present invention.

FIG. 4 is a view of an embodiment of the present invention taken along line 4-4 of FIG. 3.

FIG. 5 is an isometric view of an embodiment of the central element of the present invention.

FIG. 6 is an alternative embodiment of the central element of the present invention.

FIG. 7 is an alternative embodiment of the central element of the present invention.

FIG. 8 is an alternative embodiment of the central element of the present invention.

FIG. 9 is an alternative embodiment of the central element of the present invention.

FIG. 10A is a cross section view showing an embodiment of the present invention in an unloaded state.

FIG. 10B is a cross section view showing an embodiment of the present invention under tension.

FIG. 11A is a cross section view showing an embodiment of the present invention in compression.

FIG. 11B is a cross section view showing an embodiment of the present invention in a further compressed state.

FIG. 12 is a posterior view showing an embodiment of the present invention placed on a section of the spine.

FIG. 13 is a side view showing an embodiment of the present invention placed on a section of the spine whereby the section of the spine is in flexion.

FIG. 14 is a side view showing an embodiment of the present invention placed on a section of the spine whereby the section of the spine is in extension.

FIG. 15 is a posterior view showing an embodiment of the present invention placed on a section of the spine whereby the section of the spine experiences lateral bending.

FIG. 16 is a posterior view showing an embodiment of the present invention placed on a section of the spine whereby the section of the spine experiences axial rotation.

FIG. 17 is a cross section view showing an embodiment of the present invention actuated under shear.

FIG. 18 is a cross section view showing an embodiment of the present invention angulated.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

An implantable dynamic apparatus for stabilizing a desired region of the spine will be described with reference to FIGS. 1-18. As shown in FIGS. 1-4 the apparatus 10 of the present invention generally comprises elongated members 40 a, b mounted within a housing 20. A central element 50 having elastic properties is disposed between the proximal ends of the two elongated members 40 a, b. At least one additional flexible or compressible element 30 a, b is mounted about the proximal end of the elongated members 40 a, b adjacent the central element 50. The housing 20 encapsulates the proximal ends of the elongated members 40 a, b such that the central element 50 and the at least one additional flexible or compressible element(s) 30 a, b are contained therein.

The elongated members 40 a, b may be constructed from materials having sufficient strength and rigidity to resist fracture and plastic deformation under the loads experienced by the spine. Materials such as titanium, titanium alloy, stainless steel or a polymer such as PEEK or carbon fiber may be employed. The elongated members 40 a, b may have a variety of shapes such as cylindrical or polygonal and need not both have the same shape. The construction of the components of the apparatus 10 may be varied to meet the particular conditions of the patient in which the apparatus 10 will be utilized. For example, the material used to construct the central element 50 may be varied or the size and shape or the elongated members 40 a, b can be varied such that each member has a different shape or is constructed from a different material.

As shown in FIG. 12, one or more of apparatus 10 can be mounted between adjacent vertebral bodies 8 a, b in order to provide stability to localized regions of the spine 2. Typically, stabilization devices such as apparatus 10 are mounted to the vertebral bodies 8 a, b via an anchoring device 3. The device may comprise a member having threads at its distal end, not shown in the drawings that allow for attachment to the honey tissue of the spine and a proximal end 4 that accepts the distal ends of elongated members 40 a, b. Alternatively, the distal end may comprise a clamp or other gripping surface. A retaining member 6 locks the distal ends of the elongated members 40 a, b to the anchoring devices 3. As will be described in greater detail below, when the spine experiences the normal range of physiological motion the central element 50 and the additional flexible or compressible elements 30 a, b interact with the elongated members 40 a, b and the housing 20 to stabilize the spine while allowing for controlled movement of the adjacent vertebral bodies 8 a, b.

As shown in FIGS. 2 and 4, the central flexible element 50 is situated between the proximal ends of the elongated members 40 a, b. The shape of the central element 50 is designed to maximize contact with the proximal ends of the elongated members 40 a, b as described in greater detail below, while leaving a space 70 between element 50 and the housing 20 to allow for distortion of the shape of the central flexible element 50 when elongated members 40 a, b are moved inward.

The central flexible element 50 can be homogeneous or made as a composite to tailor its performance to the particular loading apparatus 10 experiences when implanted. In one embodiment of the present invention, the central flexible element 50 is constructed from an incompressible elastomer such that as elongated members 40 a, b are moved inwards, element 50 experiences transverse strain in response to axial strain. A flexible material having a durometer range of 30-65 on the Shore D scale or 20-95 on the Shore A scale and an elongation at break in the range of 200-600% per ASTM D-638 may be utilized to construct the central flexible element 50. The material utilized preferably is biocompatible and exhibits a consistent dynamic response and resists wear over the millions of loading cycles experience by the apparatus 10 when implanted in the spine. One such material is Polycarbonated Polyurethane or PCU known commercially as Chronoflex. One grade of Chronoflex that has been shown to function with the present invention is Chronoflex C 55D.

As shown in FIG. 10A the central element is unexpanded when the apparatus 10 is in a neutral, unloaded position. As shown in FIGS. 11A and B, when members 40 a, b are moved in the direction of arrows 62, such as would be experience when the spine is extended, element 50 eventually expands into space 70 contacting the inner wall of housing 20. With further movement of the members 40 a, b, the element 50 further expands into interstitial space 28. The expansion of the element 50 into spaces 70 and under certain conditions space 28 causes an exponential increase in resistance to compressive loading. This allows for the restricted movement of the adjacent vertebral bodies that apparatus 10 spans while also providing stability thereto.

As shown in FIG. 2, the proximal ends of the elongated arms or members 40 a, b are larger than the central and distal portions of the elongated members 40 a, b. For example, one or both of the proximal ends comprise flanges 42 a, b. The flanges 42 a, b include outer surfaces 46 a, b facing the distal end of the elongated members 40 a, b and inner surfaces 48 a, b that face the central element 50. As shown in FIG. 4, the inner surfaces 48 a, b of the flanges 42 a, b may be convex while the opposing surfaces 54 a, b of the central element 50 are concave. Alternatively, the inward surfaces 48 a, b may be generally concave while the opposing surfaces 54 a, b are convex. In addition, a variety of shapes for the two surfaces may be employed including having both surfaces be flat or having non complimentary geometries. The shape of the surfaces 48 a, b and 54 a, b will impact the angular and shear displacement between the elongated members 40 a, b. The convex and concave shape of surfaces 48 a, b and 54 a, b respectively act as a rotating joint allowing for articulation as apparatus 10 experiences angular and shear loading.

The central flexible element 50 may include one or more features on surfaces 54 a, b that allows it to interface with the flanges 42 a, b. As shown in FIGS. 2 and 5, the central element 50 includes two ribs 52 a, b on the outer surfaces 54 a, b. Each flange 42 a, b includes a slot 44 a, b that corresponds to the geometry of the ribs 52 a, b such that the ribs are received and under certain conditions engaged therein. As the elongated members 40 a, b are twisted under torsional loading, the ribs 52 a, b engage the slots 44 a, b acting to resist the twisting movement. The ribs 52 a, b are oriented orthogonally to each other to allow for more consistent performance in angulation and shear. This also allows for implantation of the device without regard to orientation.

Over time the frictional and compressive forces resulting from the contact between flanges 42 a, b and central element 50 will adversely affect the dynamic performance of element 50 due to wear and degredation. Although the central element 50 is constructed from a material that resists wear, the geometry of the features on surfaces 54 a, b may be varied in order to increase the durability of the central clement 50. FIGS. 6-9 illustrate examples of geometries that may be employed. FIGS. 2 and 6 shows a plurality of ribs 56 a, b disposed on the surface 54 a, b such that the amount of surfaces 54 a, b that contact the inner surfaces 48 a, b are minimized. FIG. 7 shows the central flexible element 50 with centrally located polygons 58 a, b. In addition, the polygons 58 a, b may have any number of sides, for example, forming a star with a plurality of points. As shown in FIG. 8 the central flexible element 50 has a plurality of polygons 58 a, b located at the perimeter of central element 50. In this embodiments polygons 58 a, b are shown with three sides but could be any number of sides and need not match each other and not be arranged in any pattern.

FIG. 9 shows the central flexible element 50 with a plurality of cylindrical protrusions 60 a, b positioned in a pattern about the surface 54 a, b of the central flexible element 50. As with the other embodiments, the cylindrical protrusions may be arranged in any manner and need not follow a pattern. In all of the shown embodiments in FIGS. 5-9, the type of engagement features on one side of the central flexible element 50 need not match the engagement features on the opposite side. For example one surface 54 a a may have a cruciform 56 a while the other surface 54 b has multiple polygons 58 b. In addition, the surfaces 54 a, b can each have different types of features such as polygons and cylindrical protrusions thereon.

As shown in FIGS. 2 and 4, a flexible element or elements 30 a, b is mounted about the proximal end of one or both of the elongated members 40 a, b. The flexible elements 30 a, b comprise a collar 34 a, b and a central region 36 a, b each interacting with housing 20 depending upon the movement of the elongated members 40 a, b. For example, the central region 36 a, b of the flexible elements 30 a, b is acted upon when the elongated members 40 a, b are moved in an axial direction. The collar 34 a, b may protrude slightly beyond the margin of the housing 20 and is acted upon when the elongated members 40 a, b are moved in an angular or radial direction. As with the central flexible element 50 one or both of the flexible elements 30 a, b may be constructed form a Newtonian material whereby transverse strain in response to axial strain is described by Poisson's ratio.

As shown in FIG. 10A an inner surface 32 a, b of the central region 36 a, b of the collar 34 a, b contacts an outer surface 46 a, b of the flange 42 a, b when the elongated members 40 a, b are in a neutral position, for example, when the spine is at rest. Alternatively, a space may exist between the surfaces 32 a, b and 46 a, b, not shown in the drawings, to allow for greater unrestricted axial movement of elongated members 40 a, b. FIG. 10B illustrates the elongated members 40 a, b subjected to an axial force causing the members 40 a, b to move distally in the direction of arrow 61 such as would be experience when the spine is flexed. The outer surfaces of flanges 46 a, b pushes on the flexible members 30 a, b at contact surfaces 32 a, b. This in turn causes flexible members 30 a, b to come into contact with the housing 20 and deform into interstitial space 28 and/or push the collar 34 a, b through an opening in the ends 21 a, b of the housing 20. The expansion of the flexible members 30 a, b into space 28 and through the ends 21 a, b of housing 20 causes an exponential increase in resistance to axial loading. This allows for the restricted and stabilized movement of adjacent vertebral bodies.

A variety of shapes and sizes can be employed for the outer surfaces 46 a, b of the flanges 42 a, b and the corresponding contacting surface 32 a, b of the flexible elements 30 a, b. The shape of these surfaces may be varied in order to create a desired dynamic response. Providing a concave shape on surfaces 32 a, b may lead to a more rapid deformation of the flexible elements 30 a, b and, consequentially more rapid stiffening to limit the range of motion for the elongated members 40 a, b. Alternatively, a convex shape may be utilized whereby the flanges 42 a, b have a thinner profile allowing for the flexible elements 30 a, b to be larger. This may provide for a greater range of motion to the elongated members 40 a, b.

As shown in FIGS. 1-4 the housing 20 may be generally cylindrical and has openings at each end 21 a, b allowing elongated members 40 a, b to pass there through. In one embodiment of the invention, the housing 20 is constructed from a generally rigid material that will not deform under the physiological loading encountered within the spine. The housing 20 may be formed from a first 20 a and a second 20 b casing wherein each of the casings 20 a, 20 b have an opening at ends 21 a, b. As shown in FIG. 4, casing 20 a includes a locking feature 22 that corresponds to a locking feature 24 on casing 20 b so as to form a snap lock. Casing 20 b also includes a plurality of expansion slots 26 that aid in assembly of the apparatus as will be described below.

As shown in FIG. 2, the apparatus 10 is assembled by aligning the proximal ends of elongated members 40 a, b with the central flexible element 50 such that the protrusions 52 a, b correspond to slots 44 a, b. The flexible elements 30 a, b, which have an opening in the center corresponding to the cross sectional geometry of elongated members 40 a, b, are then inserted over the distal ends of elongated members 40 a, b and slid into place about the proximal end thereof or in proximity to flanges 42 a, b. Thereafter, the distal ends of elongated members 40 a, b are placed through the openings in the ends 21 a, b of casings 20 a, b. The openings in the ends 21 a, b are larger than the cross sectional geometry of the elongated members 40 a, b creating a space between the elongated members 40 a, b and the housing 20. Casings 20 a, b are placed together and inward pressure applied thereon such that locking features 22 slides under locking feature 24 which moves in a radial direction as facilitated by expansion slots 26 locking casings 20 a, b together. The casings can also be assembled by welding, bolting, threading, screwing, adhesive bonding, magnetic coupling, clamping, or twist locking. Once casing 20 is assembled, the proximal ends of members 40 a, b, the central element 50, the flexible elements 30 a, b and the flanges 42 a,b are contained therein. The collars 34 a, b of flexible elements 30 a, b, however, are located in the spaces between the housing 20 and members 40 a, b and may slightly protrude through the space between the elongated members 40 a, b and the openings at the ends 21 a, b of the housing 20.

FIG. 12 illustrates the apparatus 10 implanted in the spine between adjacent vertebral bodies 8 a, b in order to provide stability to the joint existing between vertebrae 8 a, b. Typically, stabilization devices such as apparatus 10 are mounted to the vertebral bodies 8 a, b via an anchoring device 3. Once mounted to the spine 2 the apparatus 10 serves to stabilize adjacent vertebral bodies while also allowing for motion.

As shown in FIGS. 10A-B, when the spine 2 is moved in the direction of arrows 11 the elongated members 40 a, b transfer force to the flexible elements 30 a,b as described above allowing for a limited range of motion. As shown in FIGS. 11A-B and 14 when the spine is moved in the direction of arrows 12 or placed in extension the elongated members 40 a, b moved toward the central flexible element 50. The central flexible element 50 expands into spaces 70 and under certain conditions, for example increased extension of the spine creating the dynamic response discussed above. As shown in FIG. 15, the spine 2 is experiencing lateral or side bending, as indicated by the arrows 13. Under the lateral loading shown in FIG. 15 apparatus 10 a will transfer the loading forces to flexible members 30 a, b while the apparatus 10 b will transfer loading to the central flexible element 50.

FIG. 16 shows the spine rotated about its axis in the direction of arrow 14. Due to the apparatus 10 being mounted away from the axis of the spine the device 10 experiences shear loading. As shown in FIG. 17 the elongated members 40 a, b are moved in the direction indicated by arrows 63. As the elongated members 40 a, b are moved, surfaces 48 a, b and 54 a, b shift relative to each other such that flange 42 a, b is free to interact with additional flexible elements 30 a, b. As the flanges 42 a, b contact additional flexible elements 30 a, b, they impinge upon the housing 20. Thereafter, the additional flexible elements 30 a, b resist movement in the manner described above with reference to the distal movement of the elongated members 40 a, b. This dynamic response maintains the elongated members 40 a, b roughly parallel to each other as the central flexible element 50 and the housing 20 rotate.

Apparatus 10 has been described above primarily with reference to unidirectional loading conditions. As shown in FIG. 18, however, the apparatus 10 can handle loading in multiple directions simultaneously. For example, as shown in FIG. 13 the elongated members 40 a, b are moved both distally and obliquely from each other causing the additional flexible elements 30 a, b interact with the flanges 42 a, b and the housing 20 in a manner as described above. The space between the housing 20 and the elongated members 40 a, b into which collars 34 a, b are placed allows elongated members 40 a, b a range of angular motion that is restricted in the direction of movement by the additional flexible elements 30 a, b whereby collars 34 a, b act as a buffer between the housing 20 and the elongated members 40 a, b.

Although the present invention has been described above with respect to particular preferred embodiments, it will be apparent to those skilled in the art that numerous modifications and variations can be made to these designs without departing from the spirit or essential attributes of the present invention. Accordingly, reference should be made to the appended claims, rather than to the foregoing specification, as indicating the scope of the invention. The descriptions provided are for illustrative purposes and are not intended to limit the invention nor are they intended in any way to restrict the scope, field of use or constitute any manifest words of exclusion. 

1-33. (canceled)
 34. An apparatus comprising: at least two elongated members having a distal and proximal end; a first flexible element disposed between the proximal ends of the at least two elongated members; first and second additional flexible elements, each additional flexible element having a collar at least partially surrounding the proximal end of a corresponding elongated member; and a housing having a first and a second end encapsulating the proximal ends of said members such that the first flexible element and the first and second additional flexible elements are contained therein wherein the first collar protrudes through an opening in the first end of the housing.
 35. The apparatus of claim 34 wherein the proximal end comprises a flange.
 36. The apparatus of claim 35 wherein the flange comprises an inward surface facing the first flexible element and an outward surface facing the distal end of said elongated member.
 37. The apparatus of claim 36 wherein the inward surface is generally convex and contacts a surface of the first flexible element.
 38. The apparatus of claim 36 wherein the outward surface is generally concave and contacts a surface of the at least one additional flexible element.
 39. The apparatus of claim 36 wherein the first flexible member has a first and a second outward facing surface and the inward surface of each of the flanges contact the outer facing surfaces of the first flexible element to form an anti-torsional coupling.
 40. The apparatus of claim 39 wherein the anti-torsional coupling further comprises at least one protrusion on each of the outer facing surfaces of the first flexible element and at least one corresponding recess on the inward surface of each of the flanges that receives said at least one protrusion.
 41. The apparatus of claim 39 wherein the anti-torsional coupling further comprises at least one recess on each of the outer facing surfaces of the first flexible element and at least one corresponding protrusion on the inward surface of each of the flanges that receives said at least one recess.
 42. The apparatus of claim 40 wherein the at least one protrusion on a first of the outward facing surfaces of the first flexible element are oriented so as to be offset from the at least one protrusion on a second of the outward facing surfaces of the first flexible element at a pre-determined angle.
 43. The apparatus of claim 40 wherein the at least one protrusion comprises a rib that transverses the outward facing surface.
 44. The apparatus of claim 40 wherein the at least one protrusion comprises at least two transverse ribs that intersect.
 45. The apparatus of claim 40 wherein the at least one protrusion comprises at least one polygon.
 46. The apparatus of claim 34 wherein the housing, the first flexible element and the first and second additional flexible elements cooperate to define a space to permit deformation of the first flexible element in a lateral direction.
 47. A stabilization apparatus for implantation into a spine comprising: a first and a second elongated member each having a distal and proximal end; an enlarged region located at the proximal end of each elongated member, each enlarged region having an inner and an outer face; a first flexible element disposed between the enlarged regions of each elongated member; a first and second additional flexible element at least partially surrounding the proximal end of a corresponding elongated member in proximity with the enlarged regions, wherein the first and second additional elements further comprise a collar; and a housing encapsulating the first flexible element, the enlarged regions, and the additional flexible elements wherein the first flexible element and additional flexible elements interact with the enlarged regions and the housing to permit movement of the elongated members in a direction complimentary to the movement of the spine, wherein the collar of the first additional flexible element protrudes through an opening in a first end of the housing.
 48. An apparatus comprising: at least two elongated members having a distal and proximal end; a first flexible element disposed between the proximal ends of the at least two elongated members; first and second additional flexible elements disposed about the proximal ends of the at least two elongated members; and a housing having a first and a second end encapsulating the proximal ends of said members such that the first flexible element and the first and second additional flexible elements are contained therein, wherein the housing, the first flexible element and the first and second additional flexible elements cooperate to define a space to permit deformation of the first flexible element in a lateral direction.
 49. The apparatus of claim 48 wherein the proximal end comprises a flange.
 50. The apparatus of claim 49 wherein the flange comprises an inward surface facing the first flexible element and an outward surface facing the distal end of said elongated member.
 51. The apparatus of claim 50 wherein the first flexible member has a first and a second outward facing surface and the inward surface of each of the flanges contact the outer facing surfaces of the first flexible element to form an anti-torsional coupling.
 52. The apparatus of claim 51 wherein the anti-torsional coupling further comprises at least one protrusion on each of the outer facing surfaces of the first flexible element and at least one corresponding recess on the inward surface of each of the flanges that receives said at least one protrusion.
 53. The apparatus of claim 51 wherein the anti-torsional coupling further comprises at least one recess on each of the outer facing surfaces of the first flexible element and at least one corresponding protrusion on the inward surface of each of the flanges that receives said at least one recess.
 54. The apparatus of claim 52 wherein the at least one protrusion on a first of the outward facing surfaces of the first flexible element are oriented so as to be offset from the at least one protrusion on a second of the outward facing surfaces of the first flexible element at a pre-determined angle.
 55. The apparatus of claim 48 wherein each additional flexible element has a collar mounted about the proximal end of a corresponding elongated member, and further wherein the first collar protrudes through an opening in the first end of the housing.
 56. A stabilization apparatus for implantation into a spine comprising: a first and a second elongated member each having a distal and proximal end; an enlarged region located at the proximal end of each elongated member, each enlarged region having an inner and an outer face; a first flexible element disposed between the enlarged regions of each elongated member; a first and second additional flexible element at least partially surrounding the proximal end of a corresponding elongated member in proximity with the enlarged regions, wherein the first and second additional elements further comprise a collar; and a housing encapsulating the first flexible element, the enlarged regions, and the additional flexible elements wherein the first flexible element and additional flexible elements interact with the enlarged regions and the housing to permit movement of the elongated members in a direction complimentary to the movement of the spine, wherein the housing, the first flexible element and the first and second additional flexible elements cooperate to define a space to permit deformation of the first flexible element in a lateral direction. 